Guest Blog My Daughter with Schizophrenia Isn’t Living with Vancouver’s Homeless Mentally Ill….Yet

Susan Inman

The catastrophic situation of so many homeless people in Vancouver and other cities and towns in BC and across Canada is receiving a lot of media coverage. As the parent of a daughter with a severe mental illness, I see these encampments as a dire possibility once she no longer has family supporting her on a daily basis. To help avoid this fate, it’s crucial that people like her have access to the involuntary treatment that is currently supposed to be, but too often isn’t available when needed. When people with schizophrenia or bipolar disorder are in the psychotic part of their disorder, they often have anosognosia, which is a brain-based inability to realize they are ill. This is why they often refuse treatment.

Through the 23 years that my daughter has lived with schizophrenia, I’ve been immersed in the community of families living with these unexpected brain disorders. I‘ve come to know many caring, diligent parents who weren’t as lucky as we’ve been and whose sons and daughters have, at various times, been part of those who remain untreated. Even with BC’s Mental Health Act that should have ensured treatment, they didn’t receive it. They joined those who become homeless, victimized, addicted, and incarcerated.

These were people who had housing. They had families who had either bought or rented homes for them or had their family member living with them; once their family member stopped taking necessary antipsychotic medications, the chaotic psychosis was in charge of decisions.

Families like us across Canada have been failed by inadequate mental health systems that have made these tragic outcomes more likely. Part of the problem arises from the fact that the delivery of mental health services is informed by two not really compatible belief systems.

One belief system, which has gained increasing power in the last twenty years, sees all mental health problems as formed by a variety of socially determined factors. These include poverty, racism, sexism, and poor parenting. This alternative belief system, in seeking to address these problems and ensure people’s human rights, underlies fights across the country against access to involuntary treatment. However, this movement never acknowledges the evidence base informing the other belief system; contemporary psychiatric practice sees psychotic illnesses like schizophrenia as brain disorders and uses the research demonstrating that people who remain on antipsychotic medications do much better.

The alternative beliefs informed, for example, the 2021 report from Jennifer Charlesworth, BC’s Representative for Children and Youth, that clearly opposed the use of involuntary treatment. This report carefully avoided including the experiences of people like my daughter, whose involuntary access to BC Children’s Hospital meant that we finally had a way of understanding what was happening to her and how we could provide the best help.

There are already many obstacles to people getting appropriate treatment. These include the lack of public mental illness literacy campaigns that could help families and friends understand psychotic disorders and how to obtain appropriate services.

Another obstacle is the fact that adequate psycho-education for this population has basically disappeared from most mental health systems. This education is available in the now increasing numbers of Early Psychosis Intervention programs in BC, but most people don’t have access to them.

While not receiving adequate education about their illnesses, mental health clients do have increasing exposure within the mental health system itself to antipsychiatry and anti-medication beliefs. This is mostly coming from the rapidly expanding number of peer delivered services. Peers, who have some kind of mental health problem, can provide valuable services for people whose illnesses interfere with managing the tasks of daily living. However, peer leadership ensured that the Mental Health Commission of Canada guidelines and the BC guidelines for training peers don’t include education about illnesses like schizophrenia. At the same time, they promote the idea that people must always choose if they want any treatment.

A much-needed improvement would be to train all service providers to cooperate with family caregivers. For other disorders where people rely on families to manage daily life, the health care system is eager to cooperate in order to make the best medical and psychosocial recommendations. This kind of cooperation is too rare for families helping someone with a severe mental illness. The only reason that my daughter, who has struggled with the cognitive challenges that are common in schizophrenia, has done well is because we mostly have had access to this cooperation.

The biggest looming threat to people like my daughter is the current Charter Challenge to BC’s Mental Health Act from the Council of Canadians with Disabilities (CCD). If this Charter Challenge is successful, access to treatment in the too few inpatient psychiatric beds would become almost impossible for patients. People who are considered a danger to themselves or others could be admitted to a hospital, but they would have to agree to receive any medically based treatment. Proponents for the CCD’s proposed changes point to Ontario where the alternative movement has been successful in bringing in legislation blocking access to involuntary medically based treatment in hospitals. People can still be committed if they are a danger to themselves or others, but they must agree to treatment. People who pose the most severe dangers and refuse treatment can remain hospitalized blocking access to beds for other patients.

Families like mine and front line psychiatrists in Ontario report on the damage this legislation is causing. They describe the increasing number of severely mentally ill people who are no longer being treated. Even the public is seeing the impact as the growing number of random acts of violence from strangers has escalated.

The US has been dominated for even longer by the beliefs of lawyers and disability rights groups who have persuasively argued that involuntary treatment violates human rights. The consequences of their efforts have been disastrous. As the US based Treatment Advocacy Center reports, there are now ten times as many people with mental illness being incarcerated as those using the small number of inpatient psychiatric beds that remain.

Now, however, the US is confronting the misguided beliefs that have left so many people with severe, untreated mental illnesses homeless or cycling in and out of the criminal justice system. In New York and California, governors and mayors are promoting legislation that provides for involuntary hospitalization to stabilize these people and follow up with supported housing. In aiding these efforts, influential newspapers like the Sacramento Bee now headline editorials with statements like “Disability rights advocates are dead wrong for opposing Gov. Newsom’s Care Court.” The paper’s Editorial Board argues that “it’s nonsensical to leave people held hostage to their delusions in the name of protecting their highly theoretical freedoms.” They write that they don’t want to pretend that “letting people die from our failure to intervene is compassionate.”

My community is watching these fights over social policy closely. I know that reducing my daughter’s chances of lapsing into untreated psychosis and ending up in a homeless encampment depends on legislators and policy makers protecting a population they haven’t adequately recognized.

Susan Inman lives in Vancouver and the best selling author of After Her Brain Broke published by Bridgeross.

The Mental Health Industrial Complex

By Marvin Ross

This has been on my blog to do list for a few weeks and I thought how clever am I to modify the phrase military industrial complex first spoken about by Dwight D Eisenhower when he ended his presidency in 1961. It refers to the close relationship between the defence industry and the military. Then, the other day, I discovered a recent book called the Autism Industrial Complex so I’m not as creative as I thought. My consolation is what my mother always said “great minds think alike” to which she also added “but fools seldom differ”.

That book points out that “within the Autism Industrial Complex (AIC), almost anyone can capitalize on-and profit from-autism, and she (the author) also shows us how. The AIC has not always been there: it was built, conjured, created, manufactured, produced, not out of thin air, but out of ideologies, rhetoric, branding, business plans, policy lobbying, media saturation, capital investment, and the bodies of autistic people.”

One review says that “ABA (applied behavior therapy) is still widely popular with parents despite the fact that its reputation is based on a study that has never been replicated and involved the use of physical punishments on children (Broderick, 2022, p. 164). In many jurisdictions, however, ABA is the only form of treatment that is funded or insured, and this book is a strong argument as to why that has to change.  

The comment about ABA reminds me of the promotion and reliance of mental health first aid to supposedly help those with mental illness – an unproven waste as I wrote about much earlier.

What I mean about the mental illness industrial complex is the fact that there are all manner of policy researchers, policy wonks, government officials, social workers, psychologists and god knows who else, sitting around on committees and writing papers trying to develop solutions for what they call mental health. What is mental health? We all have it but some have bad mental health caused by illnesses which these people do not seem to recognize. It is like setting up committees to discuss physical health which we also all have. The plans should be for specific health problems like schizophrenia or serious and persistent mental illness rather than the vague mental health.

For serious mental illnesses, these are the problems:

1 Lack of psychiatric beds so that it is difficult to find a bed for someone who is acute but when they find one they are discharged too early because there is a backlog of people waiting to take those beds.

2. Too few psychiatrists and other dedicated staff to treat these populations

3. Little to no community programs to provide ongoing support

4. No supportive housing or affordable housing of any sort so people are discharged to shelters or to the street. Many end up in jail.

5. Insufficient funding particularly when compared to other OECD countries.

These problems have been becoming worse over the years but we have had no end of committees and task forces set up to look at them. In Ontario, which I am most familiar with, there have been 18 such groups set up since about 1989 with recommendations all being ignored. One, which I contributed to, was released in 2010 with excellent recommendations almost all ignored.

The Mental Health Commission has been around for years and has produced many reports. The Commission arose from a Senate of Canada report called Out of the Shadows. They do nothing but churn out reports and it was concluded by an independent commission in 2018 “that MHCC, in its present form and with its current orientation, is not the best instrument to achieve the objective of integrating mental health into Medicare.”

Guess what? It is still around, still generating reports and still paying people. In their last annual report, they had expenditures of around $25 million. The president and CEO earns between $272,000 and $400,000 a year. Imagine how many hospital beds could be funded for that.

Medical organizations have treatment guidelines on how to best treat people with various ailments. They know how to treat serious mental illnesses but need more money and capacity to do so but money is wasted on all these study exercises. Other groups jump in as well so Health Standards Organization which accredits hospitals and other facilities has just come out with a new set of guidelines. Their first set was lambasted because they did not think to consult with psychiatrists. If you want to read it, it will cost you $119.00.

Health Quality Ontario has also developed guidelines for community treatment that seem pretty sensible. This is one example of their recommendations “Adults with schizophrenia have a safe, affordable, stable living environment that reflects their needs and preferences.”

Necessary and laudable but where are the safe affordable supportive housing? Affordable housing is so rare that refugees from Africa recently arrived in Toronto and there was no room in the inn. They camped out on a street corner in downtown Toronto until people were so embarrassed they rallied to support them and places were found. I’m glad and don’t resent that but who has rallied to find living accommodations for the thousands of homeless Canadians many of whom have mental illnesses and substance abuse problems?

To add to the circus of so called experts feeding at the public trough of reinventing mental illness standards a new groups was set up by the Canadian Government. At the request of the Prime Minister, the Associate Minister for Mental Health and Addictions (Dr Carolyn Bennett) has commissioned the Standards Council of Canada to generate a road map on what needs to be done. The SCC “promotes efficient and effective voluntary standardization in Canada in order to advance the national economy, support sustainable development, benefit the health, safety and welfare of workers and the public, assist and protect consumers, and facilitate domestic and international trade.”

Very little is said about mental illness and that does not appear to be one of their areas of expertise so they have been bringing onboard all sorts of “experts” in the field. After almost a year of work, they still do not seem to realize that mental illness is an issue but mainly talk about mental health and addictions.

All this effort and money spent, and still no concrete plans on how to help all those who suffer and their families.

We need to end this stupidity!

We need to do what is needed!

It is going to take a long time but we have to start somewhere.

A Critical Look at Gender Dysphoria and Surgical Solutions

By Dr. David Laing Dawson

My field, broadly speaking to include doctors, psychologists and therapists of all stripes, has an unfortunate history of taking our patients’ anxieties and conflicts, usually stemming from that complex broth of nature, nurture, our intricate first 24 years of brain development, and our human awareness of self, and inventing a disease, or at least a defined and categorized “disorder”.

Part of this arises, I think, from our persistent failure to appreciate the extent to which our own presence, our words, our interpersonal exchanges and negotiations, affect the other’s perception of reality and memory.

Another part arises from our both professional and human need to categorize and label. Our patients share this need or wish. They often want a diagnosis. And then, of course, a role is played by insurance companies, our wish to have medical legitimacy, and big pharma.

In my professional lifetime we invented multiple personality disorder, and then satanic ritual child abuse. In the first instance we transformed a legitimate, entertaining literary conceit, into a medical reality. For the second, a naive psychiatrist followed his patient down a rabbit hole of fanciful experiences of cinematic child abuse and wrote a popular book about it. Both concepts flourished, and damaged thousands of lives before being debunked and diminished in size and scope.

Yet both linger on. The first in treatment programs for “dissociation disorders”, and the second in the search for, and assumption there is, an early “trauma” that would explain all of today’s anxieties and failures.

Beyond the damage these inventions have caused in and of themselves, they also undermine public understanding and empathy for actual neurological and mental illnesses. Beyond schizophrenia being persistently presented as a form of multiple personality by cinema and press, the very existence of invented fictitious diseases dilutes our concern for real diseases. Somehow schizophrenia has become a mental health issue while moments of adolescent perplexity have become disorders.

We can’t be human without being conflicted. Conflicted in our wants, desires, impressions, even our perceptions. Anxiety, stress, puzzlement, confusion are all necessary experiences in the evolution of our self awareness.

Our longest period of anxiety, confusion and puzzlement occurs in our adolescent years, and it is during those years that we are extremely and easily influenced by others, be they peers, teachers, dramatic fiction, cult leaders, popular culture, or that new phenomenon: social media influencers. The evidence is all around us in clothing, piercing, tattooing, and language fads. Every teen will say she is “expressing herself” in her clothing choices while obviously copying some trend or pop star.

In today’s popular culture there seems to be a strong belief in a journey to find oneself, one’s “true self”, as if this homunculus existed already, and awaits to be found hiding somewhere among the bushes of our seeking. Whereas, more realistically, the self we settle for (if we ever do) is an amalgam, sometimes a compromise, between our genetic directives and the stew of interpersonal and social imperatives surrounding and feeding us during our complicated brain development. To find that self, the adolescent brain really has only two basic modes of responding: reject/oppose or accept and imitate.

And today, of course, much of that interpersonal and social stew in which we simmer is virtual, distorted by social media algorithms, and often fictional. At a time when fact and scientifically established reality is readily available to all of us, we are bombarded with equal quantities of bull shit. And when we click on one piece of bull shit, Google and You Tube will start sending us endless streams of related bull shit.

Which leads me to a topic fraught with land mines: Gender dysphoria, binary, non-binary, and identity.

Now, before I go there, I have to say I have had a broad range of experiences with patients with “gender dysphoria”, from the extremes of a trans woman long post hormone treatment and surgery, now concluding it was all a mistake (“I should have been treated for obsession”), to a very smart, but socially very awkward young man, becoming a trans woman happier and more successful (socially and academically) than “she” was as a man (so far), and a young woman deciding she not only did not identify as female or male, she also did not “identify” as human. To say nothing of young men (always on the autistic spectrum) who are disgusted with their penises, to young women who have concluded, by experience, that it would be much safer to be a man.

This discourse could go in many directions but I would like to focus on the aspect implied by the opening paragraphs. We live in a time when we have cast out many rules and rituals and not found replacements, when the social stew in which our sense of self develops (in harmony or conflict with our natures) is, well, out-of-control, wild and uncontained. Dysphoria of all kinds is bound to increase. And, indeed, it has. Youth mental health is in the news every day, along with endless discussions of the effects of social media.

(How could it not increase when academic marks of A to D are replaced with terms like “emerging”, maternity nurses now talk of “chest feeding”, and almost any negative opinion is now considered “phobic”? )

So here is the question: Given all the above, might we health professionals be making matters worse by reifying this particular dysphoria, gender dysphoria, into a diagnosis (disorder, syndrome, disease)?

The numbers of children and youth diagnosed with this “disorder” are increasing at the same pace we once watched “multiple personality” and “satanic ritual child abuse” increase. The people who received these latter two “diagnoses” were of course troubled, dysphoric, seeking help, but the whole business of several named entities residing within one brain was an invention, complete nonsense, as was the whole notion that there were cadres of parents abusing and sacrificing children on Satan’s alter. As is the notion that a “person” can be born in the wrong body.

But all three situations tell us how much a confused and searching person (especially a child or teen) can be dramatically influenced by the social stew in which they live and breathe, and the damage naive counselors and health professionals can inflict when they ride the same waves of biological fictions.

To our shame we needed journalists and then law suits to stem our enthusiasm for multiple personality disorder. Perhaps we need the same with gender dysphoria disorder:

https://www.thefp.com/p/when-gender-ideology-corrupts-medicine-tavistock?utm_source=substack&utm_medium=email

Mental Health and Addictions – DO NOT Go Together Like a Horse and Carriage

By Marvin Ross

With apologies to Frank Sinatra who sang that tune. I have no idea who decided that mental health (a euphemism for severe and persistent mental illness) and addictions needed to be considered together but it is as counterproductive as combining cancer and heart disease. Severe and persistent mental illness and addictions are two distinct groups with some overlap.

Severe and persistent mental illness involves a number of conditions like chronic depression, OCD, bipolar disorder and schizophrenia with symptoms and treatments that are mostly distinct for each. Addictions involve the compulsive use of various substances despite adverse consequences. Genetic makeup can predispose some to becoming addicted.

The overlap are those with severe and persistent mental illnesses who also use substances mainly, in many cases, to self medicate their symptoms as they are untreated by doctors. In other cases, they may use in an attempt to free themselves from the boredom and futility of their lives. We treat those with mental illnesses briefly in hospital and then discharge them with little or no regard for the adequacy of housing, community treatment and meaningful work let alone financial resources. Alcohol or drugs can help give them some pleasure until they take over and their lives then spiral down even further.

To illustrate that mental illness and addictions are unique conditions, the Pew Charitable Trust in the US recently looked at the arrest records for the general population, those with mental illness only, addictions only and mental illnesses and addictions combined. Those with neither a mental illness nor an addiction had an arrest rate of 1% from 2017 to 2019. The arrest rate for those with only a mental illness was 2% while 9% of those with addictions were arrested in that period. Combining mental illness and addictions, the arrest rate went up to 12%.

Imagine the impact on the individual with only a mental illness when thrown together with those with addictions. Sadly, I’ve seen that and as I mentioned in a previous blog on supportive housing, someone who had been free of drugs for a number of years was influenced by the addicts he was housed with to go back to using and died of an overdose.

Aside from that, people with treated schizophrenia tend to be the victims of aggression rather than being violent. If they are untreated, they can be and often are aggressive but otherwise they are not. If we use arrests as found by Pew as a proxy for violence then those with addictions and combined mental illness and addictions are much more violent than those with severe mental illness. Putting people who are aggressive together with those who are passive is a prescription for trouble. That is something that I have seen.

What Pew also found was that very few of those with co-morbidities (10%) received treatment for both although as Pew said  “research demonstrates that simultaneous, coordinated treatment for multiple diagnoses produces better outcomes compared with separate treatment for only mental illness or substance use disorder.”

Kicking an addiction is not an easy task but the best motivator is having a strong desire and reason to quit. Without that, it will likely not be successful. I gave up smoking two packs a day after failed attempts because of a wife with asthma and a newborn. I had referred a few people to the person who helped and he refused them as clients because he did not feel they were sufficiently motivated. Without that motivation, success would have been difficult.

Nicotine is as difficult to stop as heroin but many do quit and, as I’ve mentioned before, people can kick heroin and other drugs. During the Vietnam War, many US servicemen were addicted to all sorts of drugs and the US was concerned that they would return to the States and continue. Most quit easily because they were out of a war zone and returned to normal lives. The point is that the soldiers had the potential to stop that behaviour which they voluntarily entered into in the first place. No one voluntarily decides to embrace a severe and persistent mental illness and to then leave it.

People I know who have been successful only managed because they had families who had the financial resources to utilize very expensive private programs.

Addiction is a problem for the addicted, their families and society as is mental illness. The option that serves all best is to provide evidence based treatment specific to each and to end muddying the waters by talking about this amorphous creature mental health and addictions. Currently, treatment and adequate resources for the mentally ill is rare and even more rare for those addicted. Instead of sufficient programs to help people quit, we focus on harm reduction which means we encourage people not to overdose and die. That avoids the real issue of rehabilitation and recovery. A dead addict is not a good candidate for rehabilitation.

Mental illness and addictions are unique and require dedicated well resourced strategies to help those who suffer. What is known to help mental illness is inadequately funded. What can help addictions for those who want help according to some experts is this. “Treatment” is based on persuasion and social pressure to stop people from using and to stay clean. The most powerful and successful forms of this are very costly and is not provided through public health but should be if we want success: This involves removal from all bad influences and sources, fulfilling and supportive and friendly activities filling every day, life style change (diet/exercise/mindfulness), all lasting at least a month in a resort-like setting far from the city, with good counseling, group counseling, and medical follow up.

Guest Blog – A Mother’s View on the State of Mental Health Care in Canada

By Marilyn Baker

It was 6:00 a.m. Vancouver time, February 2^nd, 2004. We had just gotten up when the phone rang.

“Who could be calling at this ungodly hour?” I wondered. The call display showed a 416 area code.

When I answered a woman’s voice on the other end said, “This is Dr. Goldstein. I’m a psychiatrist working at St. Michael’s Hospital emergency department in Toronto. Do you have a son, Matthew?”

My heart stopped. I sat down and said, “yes.” I was shaking.

This was the moment I had been dreading for more than a decade. I didn’t know what was coming next. I feared he was dead.

Aside from a brief visit at Christmas we hadn’t seen Matthew for more than a year. He had vanished and we didn’t know where he was.

The doctor was very good. She reassured us that he was alive, but not in good condition. He had been found unconscious in a hotel room and brought into hospital in an ambulance. She didn’t use the word suicide, but it became clear from her questions that she suspected he had tried to take his own life. She had many questions. Over the 45 minutes or so, I tried my best to answer them.

When we hung up, relief washed over me. Finally! I thought, someone – a doctor! – had discovered what we had known for years:

It was not our imagination. My son really was sick. There was something wrong with him. Specifically, there was something wrong with his brain.

But now, thankfully, he was going to get care. Treatment! Doctors and nurses were going to look after him and find out what was wrong and fix it. I laid my head on the kitchen table and wept.

Matt was admitted to the psychiatric ward in St Mike’s and seemed to be doing well. He liked the hospital and a nurse told me was he receiving Zyprexa, the brand name for a new anti-psychotic drug called Olanzapine.

Seventeen days later, the phone rang again. It was three in the afternoon, so six Toronto time. Matthew was being abruptly discharged into a freezing February night in Toronto. He had no place to stay, no friends or family nearby, no money, no identification, no nothing. He had no means to cope with the freezing cold February night.

I begged the charge nurse not to do this. Why at night? When banks were closed and hotels were probably filled. He had no money, He said everything was lost when he was admitted.

I shall never forget the charge nurse on duty. My pleas for help, for mercy, for time for me to find help for him, fell on cold deaf ears. He simply said No. No. No. Over and over again.

When I asked “Why?” he said that Matt did not have an Ontario health card so would not be allowed to go a halfway house. I tried to explain that he had applied for BC health card but he still didn’t have it. The application had been lost so we had re-applied. But the nurse was unmoved. Matthew was heartlessly discharged into a freezing February night in Toronto.

I was panicked and frantic. They were basically sentencing my son to freeze to death.

This was my rude introduction to the barbaric state of mental healthcare in Canada.

It was the night that I learned how to scramble to save my son’s life.

This was when I learned that our mental healthcare system is a cruel joke – a patchwork quilt of people not talking to other people.

All I knew then was that my son was about to be ejected into a freezing February night in Toronto, with no place to stay, no money and no identification.

Since that night, nothing has changed. In fact, it has gotten worse. In 2004 there were psychiatric hospitals. Today most are closed.

Matt was not some unlucky patient who just slipped through the cracks. They knew his illness and chose to discharge him, against all medical ethics. People with schizophrenia spectrum disorder don’t “slip through the cracks”. They slide down a large bottomless crevasse where they just disappear and won’t be made safe.

People with schizophrenia are the homeless living on our streets. They languish in our prisons. They wander the streets hallucinating, muttering to themselves, hoping against hope that someone somewhere will realize they are ill, even as they protest that they are not. Paranoid and delusional, they stab people, push strangers off subway platforms and try to behead them. They are shot by police and armed guards. Sometimes they are brutally beaten to death by police. They kill themselves when they finally realize that life is unbearable and no one gives a damn.

Mathew did survive that night. I desperately called hotels in downtown Toronto till I found one that agreed to take my credit card and let a strange man with no identity spend the night.

I wonder how many mentally ill people freeze to death in Toronto? There are probably statistics.

Matthew’s plight in February 2004 was just one of many mundane examples of how our mental “healthcare” system is failing Canadians with serious mental illness. His crisis is just one of thousands of real-life stories that happen every day of the week in caring compassionate Canada.

The phrase “the banality of evil” – written about the mind-numbing horrors of World War I – now has personal meaning for me.

No one is ever charged with negligence or failing to provide the necessities of life. These are just the mentally ill. They do not count.

The prime reason for writing this book is to raise public awareness about schizophrenia and to describe the many horrific ways that Canada fails people with this serious mental illness. The disturbing reality is that a century ago, before we knew much about schizophrenia, we treated patients much better. A hundred years ago there were asylums to take in and comfort those with dementia praecox (precocious madness), the early name given to the psychotic disorder that begins in late teens and which is now called schizophrenia.

But the situation became worse than mere ignorance. The old phrase, “nature abhors a vacuum,” coined millennia ago by Aristotle, holds true today with respect to public awareness of schizophrenia spectrum disorders (SSD). In the absence of factual information about SSD, misinformation and disinformation has rushed in to fill the void. Thus we end up not only undertreating SSDs but end up with activities that actually do harm through mistreatments and spreading of wrong information.

The lack of knowledge harmed my son because I didn’t know what to do to help him and made lots of mistakes. The reader hopefully can learn from my mistakes about what helps and what hurts!

Marilyn Baker lives in Vancouver and this is the preface to her book which is a work in progress.